Cornwall Ambulance Service Headquarters

Updated 16 May 2023

Cornwall Ambulance Service was registered in April 2020. Unit 10 in Roche, Cornwall is the location for the management of the regulated activity. The service was established as a solution for an identified gap in healthcare service provision and provides 2 services.

The first service was set up in October 2021 and is contracted until 31st March 2024. When a transfer or hospital admission is required, but does not require an emergency ambulance, this transport service provided inter-facility transfer (home to hospital or hospice) and healthcare professional admissions (such as a GP requesting a non-urgent patient conveyed to hospital for admission) urgent ambulance. The patients had already been triaged by the commissioner of the service and relevant risk assessments were already undertaken and seen by experienced clinicians from the commissioner. If a patient needed escalation of care, the provider’s ambulance would convey them to hospital.

The service provided 492 urgent patient transport journeys between healthcare establishments and admissions to hospital requested by healthcare professional since 21 March 2022 to 14 March 2023. The service does not provide routine patient transport services, for example, taking patients for dialysis or hospital appointments.

The second service is an urgent falls response. Patients who fall are categorised as a lower priority emergency than road traffic accidents, heart attacks or strokes. Due to current unprecedented demands on NHS emergency ambulance services, patients may be left lying on the floor for a prolonged time. This service provides an urgent response to patients who fall, with fast assessment and treatment in the patients’ home or community. The urgent falls response (a paramedic in an ambulance car) is available from 8am until 2am, 7 days a week. This alleviates pressure on the emergency ambulance service and meets the needs of patients who do not require an emergency ambulance but are not suitable for routine patient transport services. The urgent response falls car had attended 1,319 patients since March 2022 to 14 March 2023. This is a pilot programme from March 2022 until March 2023.

The provider is contracted to a local community interest company (a GP owned provider organisation delivering some NHS contracts across Cornwall, including Cornwall 111 Integrated Urgent Care Service) to provide both services. The provider works across Cornwall. The ambulance and falls car are dispatched through a control centre based and run by the commissioners of the service who triage, and risk assess calls and send jobs directly to the provider.

The provider also provides a mobile hot clinic for Covid testing and vaccination and training in basic and advanced life support. Neither of these are regulated activities.

The provider is registered to provide the following regulated activity:

• Treatment of disease, disorder, or injury
• Transport services, triage and medical advice provided remotely.

The location has a registered manager in post since 2020. Registered managers have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated regulations about how the service is run.

The provider employs 6 permanent staff and 41 bank members of staff.

This is the first inspection of this service since registration in 2020. The provider currently has 2 falls ambulance cars and 3 ambulances. Work is unpredictable as none is booked or planned in advance.

To get to the heart of patients’ experiences of care and treatment, we ask the same five questions of all services: are they safe, effective, caring, responsive to people's needs, and well-led?

We inspected this service using our comprehensive inspection methodology. We conducted the short notice announced inspection on 14 March 2023.

Updated 16 May 2023

We had not rated this service before. We rated it as outstanding because:

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, but it was not always completed to the provider’s target. Staff understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. The service managed safety incidents well and learned lessons from them.
• There is a truly holistic approach to assessing, planning and delivering care and treatment to all people who use services. The service did not have agreed response times but monitored and had, excellent response times. New evidence-based technologies are used to support the delivery of high-quality care. Staff are highly experienced and competent. The excellent performance is recognised by the commissioners of the service. Outcomes for people who use services are positive, consistent and regularly exceed expectations. The continuing development of the staff’s skills, competence and knowledge is recognised as being integral to ensuring high quality care. Managers, staff, teams and community services are committed to working collaboratively and have found innovative and efficient ways to deliver more joined-up care to people who use services. There is a holistic approach to planning people’s treatment or transfer to other services, which is done at the earliest possible stage.
• Feedback from people who use the service, those who are close to them, and stakeholders is continually positive about the way staff treat people. People think that staff go the extra mile and their care and support exceed their expectations. There is a strong, visible person-centred culture. Staff are highly motivated and inspired to offer care that is kind and promotes people’s dignity. Staff recognise and respect the totality of people’s needs. They always take people’s personal, cultural, social and religious needs into account. Staff are fully committed to working in partnership with people and making this a reality for each person. People are always treated with dignity by all those involved in their care, treatment and support. Consideration of people’s privacy and dignity is consistently embedded in everything that staff do. People feel really cared for and that they matter. People value their relationships with the staff team and feel that they often go ‘the extra mile’ for them when providing care and support.
• People’s individual needs and preferences are central to the delivery of the tailored services. There are innovative approaches to providing integrated person-centred pathways of care that involve other service providers, particularly for people with multiple and complex needs. The services are flexible, provide informed choice and ensure continuity of care. Technology is used innovatively to ensure people have timely access to treatment, support and care. There had been no complaints, only compliments, for the service delivered.
• The leadership is knowledgeable about issues and priorities for the quality and sustainability of services, understands what the challenges are and acts to address them. Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s values and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with commissioners to plan and manage services and all staff were committed to improving services continually.

However:

• The service did not ensure staff completed training according to the target set in the training policy. This included recognising and responding to patients with mental health needs and learning disabilities.
• Records relating to people employed did not include information relevant to their employment in the role including information relating to the requirements of Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Updated 16 May 2023

We had not rated this service before. We rated it as outstanding because:

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, but it was not always completed to the provider’s target. Staff understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. The service managed safety incidents well and learned lessons from them.
• There is a truly holistic approach to assessing, planning and delivering care and treatment to all people who use services. The service did not have agreed response times but monitored and had, excellent response times. New evidence-based technologies are used to support the delivery of high-quality care. Staff are highly experienced and competent. The excellent performance is recognised by the commissioners of the service. Outcomes for people who use services are positive, consistent and regularly exceed expectations. The continuing development of the staff’s skills, competence and knowledge is recognised as being integral to ensuring high quality care. Managers, staff, teams and community services are committed to working collaboratively and have found innovative and efficient ways to deliver more joined-up care to people who use services. There is a holistic approach to planning people’s treatment or transfer to other services, which is done at the earliest possible stage.
• Feedback from people who use the service, those who are close to them, and stakeholders is continually positive about the way staff treat people. People think that staff go the extra mile and their care and support exceed their expectations. There is a strong, visible person-centred culture. Staff are highly motivated and inspired to offer care that is kind and promotes people’s dignity. Staff recognise and respect the totality of people’s needs. They always take people’s personal, cultural, social and religious needs into account. Staff are fully committed to working in partnership with people and making this a reality for each person. People are always treated with dignity by all those involved in their care, treatment and support. Consideration of people’s privacy and dignity is consistently embedded in everything that staff do. People feel really cared for and that they matter. People value their relationships with the staff team and feel that they often go ‘the extra mile’ for them when providing care and support.
• People’s individual needs and preferences are central to the delivery of the tailored services. There are innovative approaches to providing integrated person-centred pathways of care that involve other service providers, particularly for people with multiple and complex needs. The services are flexible, provide informed choice and ensure continuity of care. Technology is used innovatively to ensure people have timely access to treatment, support and care. There had been no complaints, only compliments, for the service delivered.
• The leadership is knowledgeable about issues and priorities for the quality and sustainability of services, understands what the challenges are and acts to address them. Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s values and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with commissioners to plan and manage services and all staff were committed to improving services continually.

However:

• The service did not ensure staff completed training according to the target set in the training policy. This included recognising and responding to patients with mental health needs and learning disabilities. This was in the process of being addressed by the provider.
• Records relating to people employed did not include information relevant to their employment in the role including information relating to the requirements of Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.